Is Adjuvant Chemoradiotherapy Overtreatment in Cervical Cancer Patients With Intermediate Risk Factors?

• Published in: International journal of radiation oncology, biology, physics Vol. 79; no. 3; pp. 794 - 799
• Main Authors: Ryu, Sang-Young, Park, Sang-Il, Nam, Byung-Ho, Cho, Chul-Koo, Kim, Kidong, Kim, Beob-Jong, Kim, Moon-Hong, Choi, Seok-Cheol, Lee, Eui-Don, Lee, Kyoung-Hee
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; adjuvant chemoradiotherapy; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Cervical cancer; Chemotherapy, Adjuvant; COMBINED THERAPY; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); DISEASES; Feasibility Studies; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; intermediate risk factors; Medical sciences; MEDICINE; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - pathology; NEOPLASMS; Pharmacology. Drug treatments; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiotherapy, Adjuvant; recurrence-free survival; Retrospective Studies; RISK ASSESSMENT; Risk Factors; SURGERY; THERAPY; Treatment Outcome; Tumor Burden; Tumors; UROGENITAL SYSTEM DISEASES; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy; Uterine Cervical Neoplasms - surgery; Young Adult; intermediate risk factors; adjuvant chemoradiotherapy; recurrence-free survival; Cervical cancer; Human; Malignant tumor; Radiotherapy; Chemoradiotherapy; Survival; Female genital diseases; Chemotherapy; Treatment; Risk factor; Uterine cervix diseases; Cancer
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.11.019

To determine whether adjuvant chemoradiotherapy (CRT) improves the outcome of cervical cancer patients with intermediate risk factors. Between January 2000 and June 2006, the medical records of 735 patients who had undergone radical surgery for Stage IB-IIA cervical cancer were reviewed retrospectively. Of the 735 patients, 172 with two or more intermediate risk factors ( i.e., lymphovascular space involvement, deep stromal invasion, and tumor size ≥2 cm) were grouped as follows according to the adjuvant treatment received: 34 patients, no further treatment; 49 patients, RT; and 89 patients, CRT. The significance of the clinical parameters and recurrence-free survival of each group were analyzed. Of the 172 patients with any of the intermediate risk factors, 137 (79.6%) had two or more intermediate risk factors. Of the 172 patients, 12 developed recurrences (6.4%)->(7.0%), with 6 in the pelvis and 6 in distant sites. All 12 recurrences occurred in those who had two or more intermediate risk factors (sensitivity, 100%); however, only six recurrences were detected in patients who met the Gynecologic Oncology Group criteria for the intermediate-risk group (sensitivity, 50%; Z test, p < .05). A statistically significant difference was found in the 3-year recurrence-free survival rate among the no further treatment, RT, and CRT groups (67.5%, 90.5%, and 97.5%, respectively; p < .05). The incidence of Grade 3-4 hematologic and gastrointestinal toxicities was not signficantly different statistically between the RT and CRT groups (6.1% and 13.4%, respectively; p > .05). Postoperative adjuvant CRT can improve the outcome of cervical cancer patients with intermediate risk factors, with low increase in toxicity.